Matt Hancock faced questions on the effectiveness of the Government’s use of non-pharmaceutical interventions to control the spread of coronavirus. These include test, trace and isolate, mask-wearing, social distancing, and lockdown.
Purpose of the session
Dean Russell focused on the scientific advice behind the measures, the timing of decisions and the benefits and risks involved.
The Government’s public messaging was also examined in terms of its transparency and consistency as well as the impact on levels of trust, confidence and compliance.
The first panel of witnesses gave their assessment of the effectiveness of the action taken.
Other aspects of the Government’s response to coronavirus was also looked at, including the discharge of hospital patients into care homes, care home visiting, the procurement of PPE and future vaccines.
Professor Devi Sridhar, Chair of Global Public Health, University of Edinburgh
Alex Thomas, Programme Director, Institute for Government
Rt Hon Matt Hancock MP, Secretary of State, Department of Health and Social Care
Jenny Harries, Deputy Chief Medical Officer for England, Department of Health and Social Care
Clara Swinson, Director General for Global and Public Health, Department of Health and Social Care
Dean Russell Q1: Professor, thank you so much for being a witness today. I have a couple of questions. I was conscious that one of the comments you made earlier was about the fact that in the early stages there was a decision to let the virus go through the population. My understanding is that that would mean herd immunity; I am pretty confident that Sir Patrick Vallance repeatedly said herd immunity, or so it was said. Actually, he has said many times since then that that was not the strategy. My take was that the stay at home approach was very much an isolation strategy. I would be keen to understand a bit more what you mean by that, please.
Professor Sridhar: If you go back and read the SAGE minutes from February—they have all now been publicly released—they see this, when it emerged in January, as an uncontrollable infection. They thought that every country would succumb to it. The modelling showed that China would have over 100,000 infections a day and that 80% to 90% of the Chinese population would be exposed to it.
Then something remarkable happened. Countries started to control it. South Korea controlled its first wave. China brought down the numbers through quite a stark approach; I do not think we should take away everything from what they have done. Other east Asian countries, such as Hong Kong and Singapore—some of the ones that were earliest hit—started to manage it. All of a sudden, it became clear that it was not going to be an uncontrollable infection. It does not spread like flu. It spreads through clusters. You can contact trace it, manage it and eliminate it.
To come back to the herd immunity approach, the idea was that no country could stop it. That is what the SAGE minutes actually say. They say there is no point contact tracing because at some point it is going to be so endemic in the country. I know that herd immunity has come up over and over, and what the threshold is. It basically means that enough people have it that it stops transmitting, because there is enough immunity built up. But the threshold seems quite high.
There are two examples. One is New York City. Certain boroughs of New York City were hit incredibly hard. There was zero prevalence, which means antibody prevalence, of over 50%. They are still seeing acceleration in those communities. There are studies coming out of the Brazilian Amazon, where they have attack rates of 75% and it is still increasing, meaning that the threshold is likely to be around 80% to 90%. That is important for our vaccination strategies if we are to try to build up herd immunity through vaccination, as we have done with measles.
Dean Russell Q2: That then led to the stay at home approach anyway. Were there early mullings and discussions about that, and then the political decision made was different, or are you saying that scientifically the Government were being advised to go down a herd immunity route and they chose not to? I am trying to understand. I am sorry to ask the same question again.
Professor Sridhar: I am sorry if I did not answer it before. I think the SAGE advice changed, if you read the minutes. In February, it was to stay open and mitigate: the 2011 flu plan. In early March, when they started to model and saw the hospitalisation rate in Italy and what it would mean for the NHS, they pushed for lockdown at that point. There was always concern about the economy. If you go into these measures, what is your exit strategy? Once you lock down, how do you release restrictions?
Other countries just went into lockdowns without having a plan for how they would do it. They sorted it as they went through it, whereas, if you read the SAGE minutes, I think there was concern that if you locked down, how could you ever ease restrictions? There was the feeling that there would not be a vaccine or enough testing available in the short term. They undervalued time.
Dean Russell Q3: As a former physicist, I remember that there always used to be a joke that, if you have 10 experts in the room, you will have 11 opinions. I am interested to know from as eminent a scientist as yourself, is there a difference of view in the scientific community around all of this? Obviously, there are different views on what the outcome was. Is it a political, ideological difference in the approach? I hear many different views on the Select Committee, in the media and elsewhere, and of course reading the minutes from different meetings. I am interested to know why there is such variance in the scientific community’s approach, given what we know a year on.
Professor Sridhar: At the start, there was such uncertainty that it was like looking through fog. If I think back to January, we did not even know if there was human-to-human transmission. That was where we were. We did not understand how it transmitted. We did not know who was affected by it; there was such limited data from China. The uncertainty creates scientists guessing, based on their expertise, what they think might emerge.
We have much more consensus now, 10 months in. The consensus is around suppression. It is around test and trace. It is around buying time for a vaccine. We are even seeing Sweden moving towards that kind of approach. We have much more certainty around vaccine candidates, around therapies, around immunity, around who it affects, around hospitalisation and also around long Covid and chronic morbidity in young people. As time goes on, we will see less and less in-fighting among scientists and more and more cohesion, which is what we are seeing between SAGE, Independent SAGE and independent scientists. The majority of scientists around the world are pretty much aligned right now, whereas a year back there was too much uncertainty to be able to reach consensus.
Dean Russell Q4: I am conscious that at times Professor Whitty and Sir Patrick Vallance have come in for some quite hard talk over the year and some disagreements from the wider community. Do you think that is fair, or do you think that they have done the best job they possibly can, given what they know and their incredible track records in these areas?
Professor Sridhar: I have a lot of respect for both of them. They are both senior professionals, obviously dedicated to human health, public health and protecting life. I do not think anyone could question their motivations or their expertise.
Where we might need to look in the future is the composition of SAGE. I think there was too much put on modelling and on certain types of expertise. You did not have anyone who had public health experience. You did not have anyone with international experience of having studied east Asian responses. There were big blind spots, and it was quite a small group as well. I know they have increased it over time, but a small group of scientists was making decisions at that point, from the minutes.
In the end, it comes down to why you need scrutiny of SAGE and the science by peer review. There was no transparency in the minutes at that point, or what the basis was for following the science. I do not want to say anything negative about either of them. No one can envy the position that they are in and the decisions they are trying to make on a daily basis.
Dean Russell Q4: Across my constituency, I have been chatting to quite a few headteachers. They are concerned about the fact that they were not on the priority list—the first 11—for vaccinations. From an economic perspective, schools have helped parents go to work and made sure that grandparents are not looking after young children. I want to get a sense of why they were not on that priority list, and what other support is in place for our incredible teacher workforce.
Matt Hancock: I will give a short answer and then ask Clara Swinson to come in. The prioritisation of vaccines is incredibly important. We take advice from the Joint Committee on Vaccination and Immunisation. Our judgment is that you need to go in order of clinical priority for two reasons: the first is to reduce directly as soon as possible the number of people dying from Covid; the second is that it is the best way to recover economically as well. Stopping people going to hospital and dying from Covid is the quickest way to lift NPIs, which is the thing that will get the economy going.
On the evidence I have seen, teachers are not at more risk of catching Covid than the wider population, but I understand the pressures on teachers in particular of having to isolate if they are a contact. If we manage to get repeat testing working instead of isolation for contacts, that will be a huge benefit to schools. I hope we can get there in the new year.
Clara Swinson: The provisional prioritisation by the JCVI is based on age and is also for health and care workers. Like any other adult, a teacher under 65 who is at high risk would be covered in the one to 10, but, as the Secretary of State said, on the basis of the rest of the population. JCVI will assess each individual vaccine as it comes on, and all being well, if the vaccines come through, the Government have procured enough both for those in the first provisional prioritisation, and then we will need to move on to prioritisation for those under 65, the rest of the adult population.
Dean Russell Q5: To take that slightly further, I mentioned that schools had enabled parents to go to work. One of the things that caused a huge number of days lost in the workplace this year was the impact on mental health. One fact that I saw earlier this year, which I wrote about, was that over 32 million days of unpaid leave were taken in the UK, equating to £4.2 billion in losses. That was due primarily to sickness leave related to mental health. That risk will go forward in the next few years. I want to understand how mental health is being prioritised by the Government and the Department to support all those who are affected by the pandemic this year.
Matt Hancock: It is incredibly important. The Minister for mental health has set out more detail, in the last few hours, about extra support we are putting in to support people. There are undoubtedly mental health impacts of lockdown and, very sadly, some quite serious mental health impacts of coronavirus itself, because in some it can be a neurological condition. It is a very serious challenge, and we are putting in extra funding to support colleagues in the mental health field.
Dean Russell Q6: One thing that has emerged over the past few months is the severe impact of long Covid. What level of research is being undertaken at the moment on what the very long-term impacts of long Covid might be? I appreciate that it has not been around long enough to know all the details, but what measures are being put in place on both the research and the treatment side?
Matt Hancock: Long Covid is really serious for some people. It is a problem we have to support the NHS to address. We are doing that both through funding from the National Institute of Health Research and the NHS itself, which has now opened a long Covid service. I think eight centres are already open, and 40 will be open by the end of the year covering all parts of England. The NHS in Scotland, Wales and Northern Ireland is also working on that.
It is very difficult. As you say, the science is very early. There is also a very wide array of symptoms, so it is quite hard to get to the bottom of it, but it is very serious for those who are impacted. My heart goes out to them. It is an incredibly frustrating position to be in, especially if you are nine or 10 months on from having had Covid and are not getting better and, typically, are exhausted most of the time, often with associated pain or neurological conditions. It can be really debilitating.